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Wednesday, 4 January 2012

Dissociative Identity Disorder and Bulimia

I'm resisting the urge to make myself throw up.

There. I said it.

Sorry for saying it so bluntly, but is there a nice way to talk about self induced vomiting? 'Resisting the urge to purge?' It's yucky whatever way you say it so best to just say it and be done with it.

The question is: why? Why am I feeling this way? OK we know it's probably to do with the fact that T left and I'm seeing new T tomorrow etc, but WHY?! Why, when I've been feeling so OK about it all week and am still feeling OK about it, am I now feeling plagued by this urge which just won't go away?

I'm writing about it because maybe this will help. I'm NOT going to do it! Well, I'm going to try my best not to anyway. I haven't done it much recently. A maximum of twice in the last year I think. It should be never, obviously, but considering I used to have full blown bulimia, it's not such a bad thing that I have done it twice. Maybe it is good to remind me that I should still be careful; I'm not immune to eating disorders now just because I got better from it before. The funny thing is, I never got help with the bulimia to make it get better. I think just starting therapy with T really helped me to feel like I had some more stability in my life.

I remember, it was about my first or second session with her and she confronted me about the purging. I didn't want to talk with her about it. I felt hassled and lectured. I remember she said: "and I don't suppose I need to tell you what it does to your teeth?" or words to that effect. Knowing T now, I think she probably didn't mean to sound lecturing or annoyed, but I didn't know her then and what she said made me feel so defensive that I think I just put barriers up.

She never really talked about it again after that, even though it was something I was really worried about. I wondered if that was just what they do... psychologists: don't focus on the behaviour so as not to reinforce it? Or if she thought it better not to ask because of my reaction.

The thing about eating disorders is that they are a symptom of what's going on inside. Bulimia for me is just another symptom of the mental illness. The problem, is dissociative identity disorder. The problem, is that my structure of self is more disjointed and fluid than normal and with this problem exists other problems, like self harm, eating issues, depression, sleep problems, somatic symptoms etc. When I feel things are getting out of control internally, the problems like self harm etc become worse. These conditions are what they call 'comorbidities'. 'Morbidity' means disease. 'Co' at the start of this word, means along with or joint. So comorbidities are diseases which are present in addition to the main disease. OK so mental health problems aren't exactly 'diseases' in the way we think of them, but disease by definition is an abnormal functioning affecting the body, so mental illness kinda is a disease.

Purging for me has always been something which directly corresponds to external chaos. The times in my life where I have purged frequently have been the times in my life when I've felt things around me have been unstable and out of control. The first time it started was when I travelled to America as a student in 2004 to do a work placement. It was just after my parents had left my church (cult) and they arranged for me to stay with people they knew in America from a new church, who put a lot of pressure on me to accept what they saw as wrongs in my church and leave it to join theirs. My church had been my life until this time and was the foundation of my family. My beliefs, as warped as they may have seemed to 99.9% of the rest of the church going world, not to mention the non church going world, were my life. My church was my family. Having this foundation shaken was about as out of control as my life could be and combined with being so far from home on my own and the stresses of living with other people, I felt pretty helpless.

The people I was staying with were also extremely unhealthy and lived on junk food. Where I'd had eating issues as a young teenager (I wouldn't say 'anorexia nervosa' but definitely an extremely restricted diet) and body issues my whole life, the pressures I was feeling combined with the inability to obtain healthy food for myself drove me to make myself throw up for the first time when in America during that summer of 2004. It became the perfect solution to my predicament of only having junk food available and not wanting to gain weight. It became the perfect solution to my feelings of anxiety about my life. If I ate pizza... I threw up. If I had an argument with my housemates... I threw up. Eventually it became so that if I ate, full stop... I'd throw up.

It didn't take long before I was having nosebleeds from the pressure of vomiting and my throat was constantly raw and I felt scared and alone. After a while though, it became so easy to be sick. I hardly had to try anymore; I'd just lean over the toilet and the food would come back up. It helped every time I did it to make me feel more calm and more in control, yet at the same time, more afraid and out of control and alone. I told Adam on the phone one day and he was so angry with me. I was shocked at his reaction. I needed someone to understand my pain and I felt berated. I guess that's how I felt when T confronted me that day a few years later too. I kept doing it for several months after I got home to Northern Ireland and Adam kept hassling me about it.

Eventually I agreed that I wouldn't do it again as I could see how much it was hurting him and I didn't want to hurt anyone else in the world, least of all Adam. Being back home with Adam helped too. I went back to University here in Northern Ireland after the summer and I worked hard at resisting the urge to do it. So many times I remember standing in the hallway between my bedroom and the bathroom after dinner in a battle of wills about whether to purge or not. I'd take a few steps towards the bathroom, then go back into my room; then come out again, then stand there for a while, then eventually go back in.

After a while the urges became less strong. I focused on being healthy and I got into a really good habit of eating well and exercising. I was the healthiest I've ever been before or since during that year of 2004-2005. When I imagine what it might feel like not to have chronic fatigue and this blood disorder anymore, I think back to how I felt in that year of my life... I had energy: I joined the rowing club at Uni, I went to circuit training and swam regularly and walked everywhere. I ate a healthy breakfast, lunch and dinner everyday and every now and then went out for a slap up meal with Adam during our precious time together at the weekends and I enjoyed it, whatever it was... and the feelings of guilt were minimal.

But I feel that eating disorders affect the body in a way that stay with you. From the age of twelve my daily calorie intake goal was 400kcal. Some days I met it, other days I failed miserably (in my opinion then) ending up at 800kcal or God forbid, over 1000kcal per day. On my worst days this was still half the recommended amount for someone of my age and height and I did keep the weight off. I enjoyed looking in the mirror and pulling in my stomach and seeing the lines of my ribs and I liked feeling my pelvis bones sticking out when I was lying in bed. I wasn't underweight. I've never been underweight, but I was starving my body and I was obsessed with calories and my own body, which I hated, but that wasn't anything new. I've hated my body for as long as I can remember. I remember being taken swimming as a toddler and crying and hiding in the water because I hated how my body looked in a swim suit. I couldn't have been more than three years old then. What makes a three year old hate her body so much that she cries and wishes she was invisible?

I believe that the body adjusts to what it is exposed to. I believe my body learnt to live on 400kcal per day. Unfortunately that means that for me, eating a normal diet now equates with putting on weight. It wasn't so bad in my late teens. I certainly gained weight where my eating habits became more normal. Then after the bulimia struck in 2004, I gained weight again as my metabolism slowed down further. Then in 2008 I started therapy with the first psychologist and everything got stirred up and not surprisingly, the bulimia took off again for a short but intense period. My weight had been gradually going up and I lost a stone (14lb) in a short period of time, but once I started seeing T and things settled down, I stopped being sick and the weight went on again, with more on top as has always happened. The same again last year when I started using laxatives: some weight loss... stopped doing it... regained plus extra.

My eating habits over the last year have been more normal. When I say 'normal', it's still not healthy. I still miss meals all the time and eat the wrong things and intentionally avoid things I know I should be eating because 'we don't deserve good things'. But I don't obsess about food and feel overwhelmed with guilt when I eat anymore. My weight is much higher than I'd like, but I don't obsess about my body half as much as I did when I was four stone lighter than I am now. I know I looked better then though. Well, I probably looked my best when I was half way between then and now if I'm honest.

So now I am left in a difficult place: I have a non existent metabolism and I am not able to do any exercise (my exercise now involves sitting on the floor matching up odd socks and this makes my arms and lungs ache!) which means that if I eat more than 1500kcal per day I gain weight. I know at one stage 1500kcal would have felt like a mammoth amount to eat, but it's really not all that much and doesn't give me much room for error. And there are errors. So purging can begin to look like an option, especially when upheaval is happening in my life and I'm feeling on the edge. But I must remember that every time I go into that habit, in the long run I come out weighing more.

That's a not so brief history of my eating habits over my life. I would also say that different parts have different eating problems. Ebony is the one who doesn't eat. She starves herself. I know that much as true. Me, I don't know. My relationship with food is not simple at all, but it's healthier than Ebony's that's for sure.

4 comments:

My issue with food is hoarding it. Even if the food is something I won't eat. I work at not buying lots of extra food that won't be eaten. I think you saw the problem when you said that when you feel out of control you purge. The change in therapist would be a time when you life is out of control. Hope you can find a distraction that keeps you from harming yourself.

Thanks Ruth. Hoarding food is interesting. Do you know what your thinking behind it is? I know someone else who hoards food but she also hoards everything so I think it's just part of her disorder.

Ruth and EllenI think I am feeling things are more out of my control than usual and this is probably why my eating issues are resurfacing a bit. There are lots of changes happening for me at the moment, not only with psychology.